Normal Saline Lavage Suitable for Penile Prosthesis Salvage

CHICAGO— Salvage replacement of infected penile prostheses with normal saline lavage is safe and effective in maintaining sexual function and preventing recurrence of infection, a researcher reported at the World Meeting on Sexual Medicine.

Puneet Masson, MD, and collaborators at New York Presbyterian Hospital/Weill Cornell Medical College in New York investigated the use of normal saline washout of the implant space during revision surgery for infected penile prostheses, followed by immediate prosthesis replacement. From 2002 to 2011, 2,515 patients underwent insertion of a three-piece inflatable penile prosthesis. Of these patients, 27 (1.1%) presented with a prosthesis infection, and 18 underwent salvage surgery with placement of a semi-rigid implant. These patients underwent a standard 10-minute skin preparation with povidone-iodine scrub followed by an alcohol solution. They were given standard preoperative antibiotics for prosthesis surgery.

In all cases, the prosthesis, including the cylinders, scrotal pump, and reservoir, were removed. Intra-operative wound culturing, including specific culturing of the prosthesis components, was performed. The corpora, scrotal cavity, and reservoir pockets were then copiously irrigated with 10 to 12 liters of normal saline using a Simpulse irrigator. Gloves were changed frequently. All implants were replaced with a semi-rigid implant; four penrose drains were placed. All patients were admitted for intravenous antibiotics until drains were removed, and then discharged with four to six weeks of culture-specific antibiotics. The researchers waited three months after the salvage operation before removing and replacing the semi-rigid implant.

The median follow up was 12 months. No patient required reoperation for infection, Dr. Masson said. All patients reported use of their replacement implant. No patient had any further complications. Six (33%) patients with semi-rigid re-implants went on to have replacements with inflatable prostheses.

“These data suggests that aggressive washout rather than specificity of irrigant, along with meticulous sterile technique, may contribute to a low post-salvage infection and reoperation rate,” Dr. Masson told meeting attendees.

The meeting is cosponsored by the International Society for Sexual Medicine and the Sexual Medicine Society of North America.